V10-11 INTRAOPERATIVE COMPLICATIONS OF ROBOTIC-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION

Abstract

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-11 INTRAOPERATIVE COMPLICATIONS OF ROBOTIC-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION David G. Ortega, Michael Chevinsky, Ryan Powers, Anibal La Riva, Laura C. Perez, Aref S. Sayegh, Erik P. Castle, John W. Davis, Monish Aron, Mihir M. Desai, Inderbir S. Gill, and Rene Sotelo David G. OrtegaDavid G. Ortega More articles by this author , Michael ChevinskyMichael Chevinsky More articles by this author , Ryan PowersRyan Powers More articles by this author , Anibal La RivaAnibal La Riva More articles by this author , Laura C. PerezLaura C. Perez More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Erik P. CastleErik P. Castle More articles by this author , John W. DavisJohn W. Davis More articles by this author , Monish AronMonish Aron More articles by this author , Mihir M. DesaiMihir M. Desai More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted radical cystectomy with intracorporeal urinary diversion (RARC-ICUD) is now widely considered a standard of care treatment for muscle invasive bladder cancer with equivalent oncologic and functional outcomes compared to traditional open radical cystectomy with extracorporeal urinary diversion. RARC and ICUD each pose their own unique set of intraoperative challenges, which must be overcome and may contribute to its high complication rate. In one study of 132 patients who underwent RARC-ICUD, 30-day and 30 to 90-day complication rates were 47% and 27%, respectively. Herein, we present some of the most common intraoperative complications during RARC-ICUD and describe how to recognize and avoid them. METHODS: A compilation of video clips was collected anonymously from several surgeons to demonstrate the different intraoperative complications during RARC-ICUD. Complications were divided into those which arise during the RARC and those which arise during the ICUD. The cystectomy complications shown are multiple rectal injuries during the posterior plane dissection, sponge-stick inadvertently placed in the rectum instead of the vagina, obturator nerve injury while stapling the bladder pedicles. The reconstructive complications included right iliac artery injury during the mesenteric window creation, bowel serosa injury due to excessive traction, and several stapling complications during the ileo-ileal anastomosis such as ureter stapling to the bowel, adjacent bowel stapling, inadvertent stapling outside the lumen of the bowel, and staple line bleeding. RESULTS: Increases in operative time of patients experiencing an intraoperative complication are expected. Higher blood loss can be seen if vascular structures are involved. Increases in length of hospital stay may occur depending on the type of complication, and sequelae can occur. CONCLUSIONS: Many of the common intraoperative complications of RARC-ICUD can be easily recognized and often avoided when careful attention is paid to each step of the surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e758-e758 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David G. Ortega More articles by this author Michael Chevinsky More articles by this author Ryan Powers More articles by this author Anibal La Riva More articles by this author Laura C. Perez More articles by this author Aref S. Sayegh More articles by this author Erik P. Castle More articles by this author John W. Davis More articles by this author Monish Aron More articles by this author Mihir M. Desai More articles by this author Inderbir S. Gill More articles by this author Rene Sotelo More articles by this author Expand All Advertisement Loading ...